Last month RESULTS UK led a delegation of four parliamentarians to Liberia to see firsthand how the country is addressing major health challenges after the devastating Ebola outbreak, particularly its high infant mortality and increasing burden of tuberculosis. We were joined by the Chair of the International Development Committee (IDC) Stephen Twigg MP (Liverpool, West Derby), the Liberal Democrat Spokesperson for International Development Baroness Sheehan and two new IDC members Lloyd Russell Moyle MP (Brighton Kemptown) and Former Africa Minister James Duddridge MP (Rochford and Southend East).
The delegation visited the Pipeline clinic just outside of the capital city Monrovia to see mothers taking their babies to get immunised and weighed. This small, bustling health centre stayed open during the Ebola crisis but many of the locals from the surrounding area refused to visit due to fear of infection. Now, posters with messages and advice about the disease remain, but the clinic is overflowing with mothers, babies, children and nurses. Every time the child is due to have another immunisation, the centre phone the mother and invite her back in. She then has access to a range of services, including post-natal care and family planning. This is what primary health care should be: accessible and sustainable services for local people.
It’s hard to overstate the impact of the Ebola outbreak on health care - vaccinations and diagnoses stalled while many local health centres were abandoned. Since then, the Liberian government has been making a concerted effort to re-build the country’s primary health system and has launched a plan aimed at driving resilience in the health sector to deal with future shocks.
The UK directly supports health system strengthening in Liberia through the Health Sector Pool Fund, a mechanism focused on creating greater national ownership and sustainability within the Liberian Ministry of Health. But it also provides financing to multilateral organisations, such Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, TB and Malaria. As well as delivering the majority of funding for TB specific services in the country, the Global Fund has been working with the Ministry of Health to build a resilient and sustainable health system. It doesn’t hit the headlines but better health management, laboratory and supply chain systems are critical to achieving universal health coverage and reducing a country’s disease burden.
There are roughly 14,000 cases of TB in Liberia each year, well over double the global average. Despite the Fund’s support, just under 60% of cases go undetected. This was very apparent when the delegation met a group of young people working with the Y-Care peer educator programme in Kakata town to educate their community about diseases. One volunteer told us that the lack of awareness of tuberculosis was one of the biggest challenges that she faced.
There is only one health facility in the entire country that treats people with resistant strains of TB, the TB Annex in Monrovia. There are currently 25 people receiving treatment at the Annex for drug resistant TB. One of the people receiving treatment told the delegation that he had to leave his job and move miles away from his family to receive treatment. He worried that he wouldn't be able to get his job back once treatment was finished. Although drug-resistant TB constitutes less than 3% of TB cases in the country, it represents an ever-increasing threat. Put simply, Liberia does not have the capacity to roll out testing and treatment for drug-resistant TB.
The country’s infrastructural challenges significantly exacerbate these issues. 1.3 million Liberians live more than 5km away from a health facility. The country only has three major roads, making it incredibly difficult to travel to remote parts of the country and exacerbating inequalities between rural and urban areas. The national immunisation rate masks far greater inequalities between towns, counties, with the lowest vaccine coverage rates in the country at about 25%.
There are also inequalities within cities - a visit to West Point, a slum in Monrovia with revealed that there is just one private health centre for its 75,000 inhabitants. West Point was particularly affected by the Ebola outbreak and was even quarantined by the military for 10 days at the height of the crisis. Rebuilding trust here has not been easy. But young peer educators, funded by UK Aid Match, are trying to bridge the gap between the government, donors and the local community.
With the help of UK aid, the health system has improved greatly since the Ebola outbreak. Coverage rates for one of the routine vaccinations rose from 52% in 2015 to 70% in 2016. The challenge now is to improve those coverage rates to the World Health Organisation recommended level of 90% and to address the inequalities that exist within the country.
Liberia is a country that has faced many challenges, from its brutal civil war to the Ebola crisis. But what is clear is that the government is making real positive steps towards rebuilding the health system. Continued support to Gavi and the Global Fund is key to ensuring that the government has the resources and capacity to deliver on its plans and create a health system that works for everyone.